American Indian youth are affected disproportionately by the epidemic of obesity and its comorbidities compared with other ethnic groups in the United States. Before 10 years of age, 40% to 50% of Indian children of many communities are classified as either overweight or obese by modern definitions in contrast to data from a century ago in which Caucasian and Lakota children were equivalent in weight and body mass index. Multiple etiologies must be addressed to build programs to decrease the prevalence of childhood obesity. While awaiting definitive results from prevention and treatment trials, common-sense approaches such as encouraging healthy diets and increased activity are appropriate. A long-term approach to the community is necessary to improve the health of Indian children: short-term programs that come and go along with varying personnel may not be accepted by the community. We have achieved acceptance in Native American communities, utilizing telecommunications to introduce a family directed program that is then modified and administered by members of the community to ensure that it is culturally acceptable.